The study shows that the concern of meeting basic needs is similar for all refugee families, regardless of whether they include a person with specific needs.
The primary concern of families interviewed in both contexts was to secure an income, followed closely by related concerns about shelter, access to basic
healthcare, food and essential household items. In addition to these needs, families in Jordan expressed particular concern about the quality of drinking water, while families in Lebanon stressed problems related to access to children’s education (see Table 1).
56. www.who.int/mental_health/publications/
hesper_manual/en (accessed 28 March 2014)
57. See Annex 2
Table 1: Concerns identified by Syrian refugees in Lebanon and Jordan
Handicap International and HelpAge International, 2013
Lebanon
Jordan
Concerns Identified Concerns
priority Identified priority
Income, livelihood 27% Income, livelihood 25.6%
Shelter 13.9% Shelter 11.4%
Healthcare 11.9% Essential, non-food items 10.1%
Food 9.6% Water 9.3%
Essential, non-food items 6.9% Healthcare 8.6%
31 Section 3 – Needs and challenges of people with specific needs and their families
Consequences of unmet needs for people with specific needs
The needs identified by families with and without members with specific needs were similar. However, the study shows that for the latter group, the failure to meet both basic needs (income, shelter and healthcare) and specific needs has a major impact on their living conditions.58Protracted displacement depletes the financial reserves of refugee families and, as noted above, financial constraints are a major barrier to access to healthcare. For those with specific needs and decreased financial capacity, access to adequate healthcare is a serious concern. An assessment of livelihoods in Lebanon by Handicap
International in August 2013, found that expenditure on healthcare was an average of US$65 per month per household. For 15 per cent of Syrian refugee households in Lebanon, costs related to health were the main reason for falling into debt.59 Table 2 shows the results of the identified needs analysis for the general population and for families with specific needs by sector, as well as the concerns of those with specific needs.
58. There is growing understanding that
disability is a key issue for development. Disability, poverty and exclusion are closely linked (WHO/World Bank 2011, Mitra et al, 2012) and there is evidence that the exclusion of disabled people from labour markets has a negative impact on economies in poorer countries (Buckup, ILO Report 2009).
59. Handicap International (August 2013).
Livelihoods Assessment Report
60. The concerns related to those with
specific needs are drawn from the survey findings as well as from the operational experience of HelpAge International and Handicap International more generally. Therefore these concerns do not result solely from the survey findings in Lebanon and Jordan.
Table 2: Analysis of expressed needs by sector and by group of family surveyed
Handicap International and HelpAge International, 2013
Families without members who have specific needs
• There are significant concerns around ability to secure an income to meet daily expenditure and reduce dependency on others.
• Lack of income is identified as the greatest barrier to meeting the basic needs of the family – rent, health, food, education, household items etc.
Income
Families with members who have specific needs
• Heads of families report major challenges with the additional financial burden of a dependant with specific needs who may require medical treatment or specialised care.
• Families report having to make distressing choices between meeting the basic needs of the entire family and the specific needs of people with impairment, injury or chronic diseases.
Concerns related to those with specific needs60
• Where people with specific needs are less able to work, they may face great financial difficulty.
• Families with a member who has specific needs are often considerably smaller, resulting in a reduced support network.
• Financial difficulties can reduce access to basic services and coverage of basic needs such as nutrition and healthcare.
• Older people and people with disability often face difficulties in accessing income-generating activities. The situation is particularly acute for those with a new disability who cannot continue their existing profession and need to learn a new one.
• Families report serious concerns with the quality of shelter: it may be unsafe, poorly insulated, damp, cramped, lacking privacy, and without running water.
Shelter
• Shelter is the second most important concern of families in Lebanon and Jordan.
• Cold and damp have a negative impact on older people’s conditions such as osteoarthritis and joint pain and can cause manageable conditions to become acute and debilitating.
• Inappropriate shelter can confine older people and people with disabilities to their homes, restricting their independence, and their ability to access services and engage in livelihood and social activities.
• Refugees’ accommodation often lacks basics such as mattresses, blankets, pillows, basic furniture, kitchen and cooking utensils and heating fuel.
Essential non-food items
• Refugees surveyed in Jordan expressed a greater need for non-food/ household items than refugees in Lebanon.
• Lack of mattresses and blankets aggravate the impact of cold and damp on older people and on people living with chronic diseases/medical conditions.
• Lack of specific items for people with a disability (eg a toilet chair, an anti-pressure sore mattress) can lead to a deterioration in condition.
• Lack of access to regular and appropriate food is closely related to financial constraints.
• Vouchers have been of great help, but this type of assistance is decreasing. Half of the surveyed families were solely reliant on their own resources to buy food.
• There is concern about limited access to basic essential healthcare for maternal and child health issues and chronic diseases as well as to specialised services.
• Financial constraints are a major barrier to basic